Few managers are acutely concerned with health care except as an issue related to benefits. In that context, a manager is often more concerned with the cost of health insurance to his/her employees and by extension to his/her organization than with the underlying health care process. Lunar-based managers will by necessity view health care and its associated technologies as a critical component in the overall operation of their facility. Managing a facility on the Moon will require selfsufficiency, particularly in health care, that exceeds the most rigorous requirements for long duration activities at remote locations on earth. Appropriate medical facilities and trained personnel on site would be absolutely essential. The question of how extensive the preparations should be can be debated to a point. For example, what medical specialties are virtually mandatory as compared to those a facility might like just in case? How many medical personnel are needed and what percentage of any medical specialty should reside in any single individual? Placing all the expertise in a single individual is not much help if that person is the injured party or is unavailable for whatever reason.
Telemedicine is an obvious adjunct to having trained personnel in place as it provides extensive capabilities for additional expertise and information. The problem is that communications can fail. The inability to communicate for any reason makes a medical emergency that much more dangerous, regardless of the amount of remote support available to individuals living and working on the Moon. Diagnostic equipment must also be present for earth-based specialists to determine what the medical problem involves and how to proceed. Industrial facilities incur a wide variety of accidents that require extensive medical procedures and support for injured personnel by their very nature. The ability to move critically ill or injured personnel is unlikely even with significant improvements in transportation technology. The time and stresses required to move an individual from the Moon back to an earth facility is itself a barrier to survival and recovery. Injuries that are survivable on earth will be terminal on the moon if the capability for treatment and support is only available on earth (Eckart 1996).
Therefore, lunar-based managers will be faced with the necessity of managing a self-contained health care operation staffed with sufficient personnel as to be able to handle emergencies without earth-based support in some circumstances. These types of requirements suggest not only medical staff but support staff capable of keeping diagnostic equipment properly calibrated and in good repair. Many good hospitals do not have the capability to completely maintain and/or repair their own x-ray, MRI, blood chemistry or similar equipment without outside support. Repair of equipment implies spare parts being available or that backup exists for critical care capability. All of these things will require managerial oversight, tracking, and regular checks to insure that the medical subsystems present on the moon work well and provide sufficient capacity for typical medical situations as well as the unexpected. Managers must remember that in this environment short-term cost savings decisions could well result in extraordinary problems in an emergency and significant loss of life.